Pfizer Inc, 500 Arcola Road, Collegeville, PA 19426, USA.
Oracle Life Sciences, 2300 Oracle Way, Austin, TX 78741, USA.
Vaccine. 2024 Oct 24;42(24):126261. doi: 10.1016/j.vaccine.2024.126261. Epub 2024 Aug 31.
Clostridioides difficile (C.diff) infection (CDI) causes significant morbidity and mortality among older adults. Vaccines to prevent CDI are in development; however, data on the target population's preferences are needed to inform vaccination recommendations in the United States (US). This study assessed US adults' willingness to receive a C.diff vaccine and examined how vaccine attributes influence their choices.
A cross-sectional online survey with a discrete choice experiment (DCE) was conducted among US adults aged ≥50 years. DCE attributes included effectiveness, duration of protection, reduction in symptom severity, out-of-pocket (OOP) costs, number of doses, and side effects. The DCE included 11 choice tasks, each with two hypothetical vaccine profiles and an opt-out (i.e., no vaccine). Attribute-level preference weights were estimated using hierarchical Bayesian modeling. Attribute relative importance (RI) was compared between select subgroups.
Of 1216 adults in the analyses, 29.9% reported they knew either 'a little' (20.7%) or 'a lot' (9.2%) about C.diff before the study. A C.diff vaccine was chosen 58.0% of the time (vs. opt-out) across choice tasks. It was estimated that up to 75.0% would choose a vaccine when OOP was $0. Those who were immunocompromised/high-risk for CDI (vs. not) more frequently chose a C.diff vaccine. Decreases in OOP costs (RI = 56.1), improvements in vaccine effectiveness (RI = 17.7), and reduction in symptom severity (RI = 10.3) were most important to vaccine choice. The rank ordering of attributes by importance was consistent across subgroups.
OOP cost, improvements in vaccine effectiveness, and reduction in CDI severity were highly influential to vaccine selection. Most adults aged ≥50 years were receptive to a C.diff vaccine, especially with little-to-no OOP cost, suggesting that mandating insurance coverage of vaccination with no copayment may increase uptake. The limited awareness about C.diff among adults presents an opportunity for healthcare providers to educate their patients about CDI prevention.
艰难梭菌（C.diff）感染（CDI）会给老年人带来严重的发病率和死亡率。目前正在开发预防 CDI 的疫苗；然而，为了在美国提供疫苗接种建议，需要了解目标人群的偏好。本研究评估了美国成年人接种 C.diff 疫苗的意愿，并研究了疫苗属性如何影响他们的选择。
对 50 岁及以上的美国成年人进行了一项横断面在线调查和离散选择实验（DCE）。DCE 属性包括有效性、保护持续时间、症状严重程度减轻、自付费用（OOP）、剂量数和副作用。DCE 包括 11 个选择任务，每个任务都有两种假设的疫苗概况和一个选择退出（即没有疫苗）。使用分层贝叶斯模型估计属性水平偏好权重。比较了特定亚组之间的属性相对重要性（RI）。
在分析中，1216 名成年人中有 29.9%在研究前表示他们对艰难梭菌了解“一点”（20.7%）或“很多”（9.2%）。在所有选择任务中，58.0%的人选择了 C.diff 疫苗（vs. 选择退出）。据估计，当 OOP 为 0 时，多达 75.0%的人会选择疫苗。与非免疫受损/高危 CDI 人群（vs. 非免疫受损/高危 CDI 人群）相比，免疫受损/高危 CDI 人群更常选择 C.diff 疫苗。降低 OOP 成本（RI=56.1）、提高疫苗有效性（RI=17.7）和减轻 CDI 严重程度（RI=10.3）对疫苗选择最为重要。重要性的属性排序在各亚组之间是一致的。
OOP 成本、疫苗有效性的提高和 CDI 严重程度的降低对疫苗选择具有重要影响。大多数 50 岁及以上的成年人对 C.diff 疫苗持接受态度，尤其是 OOP 成本较低或为零，这表明强制要求医疗保险不收取疫苗接种自付费用可能会增加疫苗接种率。成年人对艰难梭菌的认识有限，这为医疗保健提供者提供了一个向患者宣传 CDI 预防的机会。
